Chen Chuanben, Chen Taojun, Huang Chaoxiong, Wang Jing, Fei Zhaodong
Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Teaching Hospital of Fujian Medical University Provincial Clinical College, Fujian Medical University Department of Radiation Oncology, Cancer Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.
Medicine (Baltimore). 2017 Nov;96(44):e8434. doi: 10.1097/MD.0000000000008434.
Nasopharyngeal carcinoma (NPC) is highly sensitive to radiotherapy. Locally advanced NPC has a relatively poor prognosis if treated with radiotherapy alone. Several studies have demonstrated that chemoradiotherapy confers survival benefit in locally advanced NPC. However, a small proportion of patients are resistant to chemotherapy based on cisplatin. So, it is important to make a valuable and inexpensive schedule for these patients. After 2 cycles of neoadjuvant chemotherapy that consisted of gemcitabine and cisplatin (80 mg/m, every 3 weeks) or paclitaxel and cisplatin (80 mg/m, every 3 weeks), magnetic resonance imaging (MRI) was used to evaluate efficacy. A total of 13 patients with extensive nodal disease or/and bulky tumors volume were determined with a stable disease (SD) and enrolled in this study. Cisplatin at a dose of 30 mg/m administered weekly concurrent with intensity-modulated radiotherapy (IMRT) was used to treat these patients resistant to neoadjuvant chemotherapy. The efficacy was evaluated by tumor response and the change of tumor volume. After the completion of concurrent chemoradiotherapy (CCRT), the overall tumor response was a complete response (CR) for 4 of 13 (30.8%) patients and partial response (PR) for 9 of 13 (69.2%) patients. The mean primary tumor volume was reduced by 59.7% and 89.8% at the 24th fraction of IMRT and after the completion of IMRT, respectively. The mean nodal volume was reduced by 63.8% and 93.5% at the 24th fraction of IMRT and after completion of IMRT, respectively. The study showed that weekly cisplatin concurrent with IMRT improved the treatment parameters for locally advanced NPC with resistance to neoadjuvant chemotherapy based on cisplatin. It was a valuable and relatively inexpensive schedule to improve the prognosis for these patients.
鼻咽癌（NPC）对放疗高度敏感。局部晚期鼻咽癌若单纯接受放疗，预后相对较差。多项研究表明，放化疗可使局部晚期鼻咽癌患者的生存获益。然而，一小部分患者对基于顺铂的化疗耐药。因此，为这些患者制定一个有价值且成本低廉的治疗方案很重要。在由吉西他滨和顺铂（80mg/m²，每3周一次）或紫杉醇和顺铂（80mg/m²，每3周一次）组成的2周期新辅助化疗后，采用磁共振成像（MRI）评估疗效。共有13例有广泛淋巴结病变或/和肿瘤体积较大的患者被判定为疾病稳定（SD）并纳入本研究。采用剂量为30mg/m²的顺铂每周与调强放疗（IMRT）同步应用，治疗这些对新辅助化疗耐药的患者。通过肿瘤反应和肿瘤体积变化评估疗效。同步放化疗（CCRT）完成后，13例患者中有4例（30.8%）达到完全缓解（CR），9例（69.2%）达到部分缓解（PR）。IMRT第24次分割时和IMRT完成后，原发肿瘤平均体积分别减少了59.7%和89.8%。IMRT第24次分割时和IMRT完成后，淋巴结平均体积分别减少了63.8%和93.5%。该研究表明，顺铂每周与IMRT同步应用改善了对基于顺铂的新辅助化疗耐药的局部晚期鼻咽癌的治疗参数。这是一个有价值且相对成本低廉的方案，可改善这些患者的预后。
